Michelle Vargas of Granite City, Illinois, has always vaccinated her 10-year-old daughter, Madison. They both typically get flu shots. But when a vaccine for the coronavirus eventually comes out, Vargas will not be giving it to her daughter — even if Madison's school district requires it.
"There is no way in hell I would be playing politics with my daughter's health and safety," said Vargas, 36, an online fitness instructor. If the public school Madison attends and loves says the vaccine is mandatory, "we would find other options," she said.
As pharmaceutical companies race to manufacture a Covid-19 vaccine, many people are wary of a shot that is working its way through the approval process at record speed during a highly politicized pandemic. While some professions could require employees to get the vaccine, experts say schools almost certainly will require students to — potentially setting the stage for a showdown between reluctant parents and education officials.
"We want to make sure kids return to in-person learning as quickly as possible, and we do see a vaccine playing a huge part in the process," said school law attorney Brian Schwartz, an adjunct professor of education law at the University of Illinois Springfield. "This is going to be a huge issue, and I don't think most people understand that yet."
It is an especially delicate time for parents to hesitate about vaccinating their children. Vaccines have long been a hot button issue, particularly as a small but vociferous group has spread false information, such as the debunked myth that the measles-mumps-rubella shot causes autism.
As with other vaccines, the decision whether to require one for Covid-19 in schools will be made at the state and school district levels. While all 50 states require student vaccinations, a patchwork of laws allows for parental objections: All states allow for exemptions for children with medical reasons, and 45 states plus Washington, D.C., grant exemptions on the basis of religious objections, according to the National Conference of State Legislatures. On top of that, 15 states allow for philosophical exemptions for people who object to immunizations on the basis of personal, moral or other grounds.
Opponents have already started sharing outlandish lies on social media about the Covid-19 vaccines in development, but this time, conspiracy theories have not been needed to sway some who otherwise dutifully immunize their children.
A Gallup poll released in August found that 1 out of 3 Americans would not get the Covid-19 vaccine if it were ready now, even if the vaccine were free. A month later, a smaller USA Today/Suffolk University poll found that two-thirds of U.S. voters do not want to get the coronavirus vaccine when it becomes available. Those polled said that they felt there will be insufficient data on the long-term effects of a rushed vaccine and that they are suspicious that pressure from President Donald Trump ahead of the election could compromise its safety standards.
Vargas, who has never before considered herself opposed to vaccinations, shares those worries.
"I understand that time is of the essence and a lot of people want to get on with their lives," she said. "But any time anything is rushed, integrity goes out the window."
Will a Covid-19 vaccine be safe for children?
There is no question that the hunt for a worthy coronavirus vaccine is happening on an accelerated timetable.
Vaccines typically take years, sometimes decades, to develop. Yet in April, through an initiative called Operation Warp Speed, the Trump administration announced that it aimed to "deliver 300 million doses of a safe, effective vaccine for COVID-19 by January 2021." It's a lofty promise that the government's top infectious diseases expert, Dr. Anthony Fauci, has said he believes could be possible — although he has added that he fears that the "Star Trek"-inspired moniker of the operation could fuel public distrust in it.
The Covid-19 vaccine will come as public health officials battle a growing number of anti-vaccine hot spots across the United States, which have contributed to outbreaks of diseases such as measles that were once eradicated in this country,
It also comes as several groups are uniting in their doubts about public health initiatives, said Dr. Howard Markel, a pediatrician who is director of the Center for the History of Medicine at the University of Michigan.
"You've got anti-vaxxers who are protesting along with libertarians and anti-government people and people who don't trust science or politicians. It's not a monolithic group," he said. "I don't know how it's going to roll out, but it's not going to be pretty."
Despite the unparalleled speed of the Covid-19 vaccine trials, experts said they have confidence that the protocols for safety and efficacy are being followed. An incident this month, when reported spinal cord damage in one participant briefly halted AstraZeneca's vaccine trials, proved that "the system worked," Markel said.
Dr. Yvonne "Bonnie" Maldonado, a professor of pediatrics, epidemiology and population health at the Stanford University School of Medicine, urged parents to ask trusted providers, such as their pediatricians, for as much information as possible about the vaccine whenever it comes out.
"I don't think we can make a decision one way or the other until these trials are finished and we have the data in front of us," she said. "But I think it's even more important to emphasize that we have a lot of confidence in the vaccine development structure in the U.S. and elsewhere, and you really see that the process seems to be working well so far."
"What we want to do is certainly maximize the number of children who receive the vaccine, which will, in turn, help build herd immunity for those kids who aren't vaccinated or can't be vaccinated."
Schwartz echoed the need for parents to be educated.
"Once we do have a safe and reliable vaccine, it's really incumbent on school districts and public health departments to provide information," he said. "What we want to do is certainly maximize the number of children who receive the vaccine, which will, in turn, help build herd immunity for those kids who aren't vaccinated or can't be vaccinated."
When will a Covid-19 vaccine be available?
Officials have some time to convince hesitant parents.
Dr. Robert Redfield, director of the Centers for Disease Control and Prevention, has said a Covid-19 vaccine will likely not be widely available until summer or fall 2021. And if the vaccine does get approved in the coming months, children are so far down on the priority list for it that they would not be offered it right away: Health care workers, those with underlying conditions that put them at higher risk and older people are in line to get the first batch, while teachers are among those supposed to get the second.
But some educators, particularly those returning to in-person classes, may push for students to be moved higher up in the queue. While children generally do not get as severely ill from the coronavirus as adults do, research is mixed on whether kids, especially those under 10, can transmit it as easily as adults.
At the moment, no children are included in the vaccine trials, another source of concern among some parents. Regardless, the surgeon general has authorized pharmacists to administer the future vaccine to children ages 3 and older.
Katie Otteni, 24, of Hickory, North Carolina, has never vaccinated her 22-month-old son, Dallas, and she has used the religious exemption to skirt his day care center's vaccine requirement. She and other like-minded friends embark on postcard campaigns to educate others about what they say are the dangers of vaccines, and she has been encouraged to see parents who normally do not agree with her expressing reluctance about any coming Covid-19 vaccine.
"It's crazy, because this one vaccine they feel this way towards, but if they knew there was the same situation going on with the others, they would probably think differently," said Otteni, a waitress. "But it's a start."
Doctors and public health officials disagree. Vaccinations are considered one of the 10 greatest public health achievements of the 20th century, and by and large, they have repeatedly been proven to be safe.
With the pandemic, a vaccine may be our only way out, said Dr. Lauren Grossman, an assistant professor of emergency medicine and general internal medicine at the University of Colorado School of Medicine.
"In this particular case, I don't see how we have much of a choice, to be honest," she said. "Look at what we're going through now with schools reopening."
A bellwether of how parents might respond
While various childhood immunizations are required to attend public schools, the annual flu shot is not mandated in most states — although this year, some school districts have deemed it necessary to reduce the possibility of simultaneous flu and Covid-19 outbreaks.
The new requirement has been met with consternation in some places. In Massachusetts, hundreds of parents protested the flu shot rule in August, holding signs in front of the State House that read, "My child, my choice," The Republican newspaper of Springfield reported.
"It's a bigger lift for school districts to require flu shots than it is for vaccines," said Dan Domenech, executive director of AASA, The School Superintendents Association, an advocacy organization for the 14,000 superintendents in the U.S. "The other vaccines you don't have to get every year. Once you have it, you have it."
The response to flu shots could be a bellwether of what school districts will face if they require the coronavirus vaccine. Domenech said he expects lawsuits from parents who do not feel comfortable injecting their children with a new vaccine should schools eventually require it, especially because each person could need two doses to gain even some immunity — an even bigger ask of parents.
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But Schwartz, the education law attorney, said such lawsuits would be unlikely to hold up in court — as long as schools offer an alternative to in-person learning for students whose families refuse to vaccinate them.
"My take is that as long as the school system provided the child with a quality instructional program, whether it be in person or remote, that the parent is going to have an uphill battle in a lawsuit against the district," he said.
Vargas, the Illinois mother, sees a flu shot with an extensive safety record as very different from a brand new vaccine.
"This is not something you want. Period. And if we can prevent it, we need to do so."
"People want to get it out there and go on with their lives," she said. "But at what cost?"
Markel, the medical historian, sees a greater danger in not having a vaccine. His mother died of Covid-19, and he has patients who are enduring long-lasting neurological symptoms.
"Kids can get it," he said. "This is not something you want. Period. And if we can prevent it, we need to do so."